Development and Validation of a Plastic Surgery-Oriented Anatomical Scoring System for Surgical Indications in Vulvar Lichen Sclerosus.

Authors

Minlu Huang, Meichen Liu, Yilin Li, Yujiao Cao, Yu Zhou, Qiang Li, Fengyong Li

Published in

The Journal of craniofacial surgery. Sep 18, 2026. Epub Sep 18, 2026.

Abstract

Vulvar lichen sclerosus is a chronic inflammatory condition that often leads to progressive anatomical distortion and functional impairment. For patients with advanced-stage disease, surgical intervention becomes a treatment option. However, a standardized tool to guide surgical decision-making from a plastic surgery perspective is currently lacking.
A retrospective cohort study was conducted on 27 patients with vulvar lichen sclerosus who underwent reconstructive surgery. A novel anatomical scoring system was developed based on 4 domains, including the clitoral hood, vaginal outlet, labia minora, and labia majora. Each domain was scored independently from 0 to 3 according to anatomical changes and corresponding clinical symptoms. Two independent plastic surgeons performed all assessments. Interrater reliability was evaluated using the intraclass correlation coefficient. The concordance between threshold-defined surgical indications and actual surgical procedures was examined to assess clinical validity.
The mean age of the cohort was 38.3±10.0 years. The scoring system demonstrated excellent interrater reliability, with an intraclass correlation coefficient of 0.965 for the total score. The optimal cutoff values determined by the minimum misclassification method were 4 for the clitoral hood, 2 for the vaginal outlet, 3 for the labia minora, and 4 for the labia majora.
This Plastic Surgery Anatomical Scoring System for Vulvar Lichen Sclerosus provides a valid tool for standardizing surgical indications. By linking each anatomical domain to a specific reconstructive procedure, it can help plastic surgeons decide not only whether to operate but also which procedure to perform.

PMID:
42757933
Bibliographic data and abstract were imported from PubMed on 18 Sep 2026.

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